Royal Society for Public Health, Building Capacity: Realising the potential of community pharmacy assets for improving the public's health (November 2016)

There are approximately 42,990 registered pharmacists and 19,311 registered pharmacy technicians in England.

There is a growing evidence base demonstrating not only the clear appetite of pharmacists and their teams to adopt a public health role, the tangible support and trust from the public, but also the effectiveness with which pharmacy is promoting the public’s health across the UK.

The pharmacy environment itself, and the anonymity it offers, may also provide a location that is more conducive to discussing health issues and reaching groups typically seen as ‘hard to engage’, for whom visiting a GP surgery may be an intimidating experience.

Overall, the evidence to date demonstrates the wide-ranging benefits of pharmacy-based public health services, from clear public support, effective service provision to improved workforce morale and most importantly, potential to improve the public’s health.

When only considering those who currently commission pharmacy to provide these services, the proportion who considers them to be an effective provider rises yet further, to 79.1% for flu vaccinations, 85.36% for emergency hormonal contraception and 80.55% for substance misuse services.

There is strong feeling amongst pharmacists, LPC chief officers and commissioners alike that pharmacy is being under-utilised in the provision of public health services.

Less than one in five of pharmacy team respondents (18.50%) felt that pharmacy is being fully utilised, with almost three-quarters answering negatively to this question (74.19%). Similarly, over three-quarters of commissioners (75.76%) and 100% of LPC chief officers felt that pharmacy is not being fully-utilised.

There are a number of issues faced by community pharmacies that are impeding their public health role; these include issues around capacity, the tendering process, public awareness and also, challenges within the commissioning landscape.

Less than one in five (18.18%) of commissioner respondents stated that their local Health and Wellbeing Board has a pharmacy representative.

An opinion poll conducted in March 2016 demonstrates that public awareness of pharmacy-based services varies greatly according to the service in question, and for some services, continues to lag behind that for GPs. Awareness ranges from a positive 74% for the treatment of minor ailments to 44% for NHS Health Checks.

Local Government Association, The community pharmacy offer for improving the public's health: a briefing for local government and health and wellbeing boards (March 2016)

Pharmacies are located at the heart of communities, with trusted professional on site who reflect the social and ethnic backgrounds of their residents.

Pharmacies are uniquely placed to deliver public health services due to their access, location and informal environment with 95% of the population within 20 minutes of their local pharmacy.

Community pharmacies are not only a valuable health asset, but also an important social asset, because often they are the only healthcare facility located in an area of deprivation.

Pharmacy staff have the potential to play a critical role in improving the health of deprived communities by offering convenient and equitable access to health improvement services.

Pharmacy staff reflect the social and ethnic backgrounds of the community they serve and they are accessible to deprived individuals who may not access conventional NHS services, which help to improve health inequalities.

Patients and the public trust their pharmacy teams and build a special relationship with them due to frequent contact, so that people are able to be honest with them about their lifestyle choices, for example, the number of cigarettes they smoke.

The local pharmacy is often patients’ and the public’s first point of contact and, for some, their only contact with a healthcare professional.

79% of people have visited a pharmacy at least once in the last 12 months, 37% visit at least once a month.

Over 9,000 pharmacies in England supported Smoke Free January in 2015.

Nearly 10,000 pharmacies supported Stoptober 2015.

Over 90%of pharmacies now have a private consultation room and many have already taken on a wider public health role, for example, running weekly clinics to help people lose weight, stop smoking or to monitor blood pressure or cholesterol.

Pharmacies are increasingly seen as a referral mechanism to GPs for patients with possible early symptoms of cancer.

in 2015, over 8,000 (nearly 70%) of pharmacy contractors had signed up to deliver the seasonal flu vaccination, with almost half a million vaccinations having been delivered by 20th November.

Community pharmacies are accessed by people who may not access conventional NHS services, helping to reduce health inequalities. For example, people from deprived communities and ethnic background, asylum seekers, travellers, etc.

It takes five years to qualify as a pharmacist. During a four-year master’s degree, trainee pharmacists are being trained in the safe use of medicines and, increasingly they are being trained to help people change to more healthy behaviours by equipping them with the appropriate behaviour change skills.

UCL School of Pharmacy, Primary Care in the Twenty-first century (Jan 2016)

There are around 30,000 community pharmacists employed in England, which represents a similar number to that for GPs.

English community pharmacies are supported by over 100,000 other staff, ranging from registered pharmacy technicians to counter assistants with varying levels of training.

At present, pharmacy is the only health profession with a surplus of UK educated graduates. This provides evidence that there is a genuine opportunity for extending the clinical role of NHS community pharmacists, provided service users find this an attractive option and that pharmacist and other stakeholders have the necessary motivation to extend their clinical care inputs.

Since the 1950s there has not been an increase in the number of registered pharmacists working per community pharmacy comparable to that seen in relation to the number of doctors working per general practice.

Relatively few pharmacies have more than one registered pharmacist on duty at any one time.

Outside London, over 60% of all community pharmacies are now grouped in chains of five or more.

The time the annual number of prescription items dispensed by community pharmacies in England alone is now over a billion. This compares with about 200 million in 1950 and 500 million at the beginning of this century.

The role of community pharmacy

There is a large body of evidence indicating that community pharmacy can play an extended part in delivering accessible health care, alongside roles like reducing prescription errors and facilitating better medicines use.

Increasing the number of clinical pharmacists working in GPs is a valuable step. But it cannot substitute for a clear vision for the future of community pharmacies as ‘first contact’ health care providers.

If community pharmacists successfully extend their clinical care roles this would free general practice and linked community capacity to work towards reducing inappropriate hospital admissions and unduly long inpatient stays.

Without well planned, pro-active, interventions pharmacy skills will be under-used and the established community pharmacy network lost.

If each community pharmacy in England were able to take on just 10% of the average general practice’s existing workload over the next five years, this will release approaching 5,000 GPs and similar volumes of practice staff for additional service provision.

PSNC contractor database (accessed Jan 2015)

There are over 11,700 NHS community pharmacies in England.

Vet futures, Public trust in the veterinary profession (May 2015)

Pharmacist came out as the most trusted profession in a recent survey of over 2,000 members of the public – 97% trusted pharmacists putting them above other key professions including opticians, dentists and GPs.

87% of survey participants using pharmacy services were either satisfied or very satisfied with the service they received, again putting pharmacists in top ranking position.

An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation BMJ Open (May 2015)

Overall, 84.8% of the population is estimated to live within a 20 min walk of a GP premises: 81.2% in the most affluent areas, 98.2% in the most deprived areas, 94.2% in urban and 19.4% in rural areas. This is consistently lower when compared with the population living within a 20 min walk of a community pharmacy.

Royal Society of Public Health, Reducing premature mortality: the role of community pharmacists (February 2015)

The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England. BMJ Open (August 2014)

Overall 89.2% of the population is estimated to have access to a community pharmacy within a 20 minute walk. For urban areas, that is 98.3% of the population, for town and fringe, 79.9% of the population, while for rural areas, 18.9% of the population.

An estimated 99.8% of people from the most deprived areas live within just a 20 minute walk of a community pharmacy.

For areas of lowest deprivation 90.2% of the population have access to a community pharmacy within 20 min walk.

Research findings for Health & Social Care (June 2014)

Carers rated the pharmacy as the most carer-friendly service they receive out of all community services across health, social care, work, transport and education: 67% of carers rated the pharmacy as carer–friendly; only 8% of carers rated the pharmacy as not carer-friendly at all.

Every year the NHS deals with 438 million visits to a pharmacy in England for health related reasons.

Community pharmacies are an under-used resource: many are now open 100 hours a week with a qualified pharmacist on hand to advise on minor illness, medication queries and other problems. We can capitalise on the untapped potential, and convenience, that greater utilisation of the skills and expertise of the pharmacy workforce can offer.

Pharmacists, with four years of training, have a wealth of knowledge and experience. They can advise on minor ailments, medication and prescription concerns and many have consultation rooms. We intend to ensure that these are utilised more effectively.

Department of Health, Pharmacy in England Building on strengths – delivering the future (April 2008)

84% of adults visit a pharmacy – 78% for health-related reasons – at least once a year. Three-quarters of people have visited in the last six months.

Excluding those who report never visiting a pharmacy, an adult visits a pharmacy 16 times a year, of which 13 visits are for health related reasons.

An estimated 1.6 million visits take place daily, of which 1.2 million are for health-related reasons.

Women, those aged over 35 and those with a long term health condition or disability are frequent users.

In England, most people’s first – and sometimes only – contact with a pharmacist is through their local community pharmacy.

Pharmacies provide a convenient and less formal environment for those who cannot easily access or do not choose to access other kinds of health service, or who simply want readily available, sound professional advice and help to deal with everyday health concerns and problems.

England has a highly trained and experienced pharmacy workforce.

Pharmacy has much to offer in helping to meet rising expectations – not only in promoting better health and preventing illness but also in contributing to the effective delivery of care closer to home and in the community.

The Government makes clear its conviction that, as health professionals, pharmacists remain a significant untapped resource for delivering accessible services to the people who need them most.

The F-Code or ODS code is the the unique code issued to your pharmacy which identifies you to NHS Prescription Services. You can find this on any pricing authority statement or your prescription submission document (FP34c).